Increased intra-abdominal pressure linked to worse long-term prognosis among patients with orthotopic liver transplantation: a retrospective, observational study

Objective To investigate the prognostic value of intra-abdominal pressure (IAP) among patients with orthotopic liver transplantation (OLT). Patients We enrolled adult patients admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University after undergoing liver transplantation from January 2018 to March 2022. Methods and results A total of 382 patients were included, with 73 patients who died within 1 year after admission. Intra-abdominal Hypertension (IAH) was defined as a sustained IAP >= 12 mmHg. The incidence of IAH among liver transplant patients was 46.2%. The IAP and sequential organ failure assessment (SOFA) scores were significantly lower in survivors than non-survivors (P < 0.05). Restricted cubic spline (RCS) analysis found that an IAP level above 16 mmHg was significantly associated with an elevated risk of 1-year mortality, and Kaplan-Meier survival curves further validated this finding (log-rank P < 0.001). Multivariate Cox proportional hazards regression model indicated that patients in IAH grade III (HR: 3.16, 95% CI: 1.31-7.62, P = 0.010) and IV (HR: 9.93, 95% CI: 2.84-34.7, P < 0.001) had significantly higher 1-year mortality risks adjusted by SOFA score classifications compared to individuals without IAH. Maximum IAP levels alone and a modified SOFA score incorporating IAH grade demonstrated satisfactory performance in predicting in-hospital mortality among OLT patients (AUC: 0.710, 0.834, respectively). Conclusions Elevated intra-abdominal pressure above 16 mmHg was significantly related with worse 1-year survival among OLT patients. Both maximum IAP alone and SOFA score incorporated with IAH components showed strong prognostic values for in-hospital mortality of these individuals.